Evaluation of Risk Factors for Lung Cancer Among Never Smokers and Their Association With Common Driver Mutations.

INTRODUCTION: The majority of lung cancers are caused by tobacco use, which is linked to lung tumors of all major histological types. A considerable fraction of lung cancer cases, the vast majority of which are adenocarcinomas, occur in "never smokers," who are characterized as having smoked fewer than 100 cigarettes in their lives. The primary objective was to assess risk factors for lung cancer in non-smokers. In contrast, secondary objectives included evaluating histological subtype, staging, and performance status and exploring associations between risk factors and common driver mutations. MATERIAL AND METHODS: The study was a single-center, observational, case-control study done at All India Institute of Medical Science, Bhubaneswar, India that focused on non-smokers with lung cancer. It included 145 cases and 297 controls, with statistical analyses such as chi-square tests and logistic regression used to assess associations between risk factors and lung cancer, considering factors such as socioeconomic status, body mass index (BMI), occupation, outdoor and indoor air pollution, personal habits, and medical history. RESULTS: The study, comprising 145 lung cancer cases in non-smokers and 297 controls, found that 92.4% (134/145) of cases had adenocarcinoma, 6.9% (10/145) had squamous cell carcinoma, and 0.7% (1/145) had small cell carcinoma. Significant associations were observed for high-risk occupations, indoor biomass use without proper ventilation, low BMI, and family history of lung cancer. Specific pre-existing lung conditions like old pulmonary tuberculosis and asthma were linked to increased and decreased odds of developing lung cancer, respectively. Environmental factors, living near heavy industry, and dietary habits showed significant associations. A significant association was not found between the driver mutations and the risk factors studied. CONCLUSION: This single-center study sheds light on significant risk factors influencing lung cancer development among non-smokers. The predominant occurrence of adenocarcinoma and associations with high-risk occupations, indoor biomass exposure, low BMI, and family history emphasize the multifaceted nature of non-smoking-related lung cancer. The findings underscore the importance of comprehensive risk assessment and targeted preventive strategies in this population.

Exploring the Impact of Occupational Silica Exposure Progressing to Systemic Sclerosis: A Report on the Development of Silica-Induced Systemic Sclerosis Cases.

Erasmus syndrome is an uncommon disease brought on by exposure to silica and later manifests as systemic sclerosis (SSc) with or without silicosis. The body of literature on Erasmus syndrome is scarce. Here, we report two cases of male patients presenting with SSc after silica exposure. One of the patients had worked in the steel industry, and another had worked in the sculpture manufacturing for a decade before the presentation. It is imperative to raise awareness of this uncommon illness because avoiding further exposure remains the mainstay of management. Our case reports reemphasize the importance of occupational history in all patients of SSc.

A Prospective Observational Study of Diagnostic Reliability of Semiquantitative and Quantitative High b-Value Diffusion-Weighted MRI in Distinguishing between Benign and Malignant Lung Lesions at 3 Tesla.

Aim The aim of this study was to evaluate the usefulness of high b-value diffusion-weighted imaging (DWI) to differentiate benign and malignant lung lesions in 3 Tesla magnetic resonance imaging (MRI). Materials and Methods Thirty-one patients with lung lesions underwent a high b-value (b= 1000 s/mm 2 ) DW MRI in 3 Tesla. Thirty lesions were biopsied, followed by histopathological analysis, and one was serially followed up for 2 years. Statistical analysis was done to calculate the sensitivity, specificity, and accuracy of different DWI parameters in distinguishing benign and malignant lesions. Receiver operating characteristic (ROC) curves were used to determine the cutoff values of different parameters. Results The qualitative assessment of signal intensity on DWI based on a 5-point rank scale had a mean score of 2.71 ± 0.75 for benign and 3. 75 ± 0.60 for malignant lesions. With a cutoff of 3.5, the sensitivity, specificity, and accuracy were 75, 86, and 77.6%, respectively. The mean ADC min (minimum apparent diffusion coefficient) value of benign and malignant lesions was 1. 49 ± 0.38 × 10-3 mm 2 /s and 1.11 ± 0.20 ×10-3 mm 2 /s, respectively. ROC curve analysis showed a cutoff value of 1.03 × 10-3 mm 2 /s; the sensitivity, specificity, and accuracy were 87.5, 71.4, and 83.3%, respectively. For lesion to spinal cord ratio and lesion to spinal cord ADC ratio with a cutoff value of 1.08 and 1.38, the sensitivity, specificity, and accuracy were 83.3 and 87.5%, 71.4 and 71.4%, and 80.6 and 83.8%, respectively. The exponential ADC showed a low accuracy rate. Conclusion The semiquantitative and quantitative parameters of high b-value DW 3 Tesla MRI can differentiate benign from malignant lesions with high accuracy and make it a reliable nonionizing modality for characterizing lung lesions.

Knowledge, Attitude, and Practices Among Healthcare Practitioners in the Context of Multidrug Resistance Tuberculosis: An Appraisal to Disease Elimination.

INTRODUCTION: Tuberculosis (TB) remains one of the leading infectious causes of death worldwide, and India is among the countries with the highest TB burden. TB control is facing several roadblocks in our country with the rapid development of multidrug-resistant (MDR) as well as extensively drug-resistant TB (XDR) and as an after-effect of the global COVID-19 pandemic. With the target of TB elimination by 2025 (National Tuberculosis Elimination Program, NTEP), there is a need that treating physicians in our country be well aware of MDR-TB and be able to diagnose and treat it at an appropriate time. The present study is conducted to explore the knowledge levels, attitudes, and practices concerning MDR-TB amongst healthcare professionals working in different healthcare sectors. METHODS: A total of 250 allopathic medical practitioners (Bachelor of Medicine and Bachelor of Surgery [MBBS], specialists, and superspecialists) working in any sector (private or government), who are directly involved in managing any form of TB patient and are willing to undertake the assessment, were included in this online questionnaire-based survey that was circulated using various social media platforms like WhatsApp, Facebook, Linked In, and Gmail. Responses to the questionnaires created in Google Forms were analyzed by capturing data in a Microsoft Excel® spreadsheet for further statistical analysis. The data were analyzed using multiple measures of dispersion and cross-tabulations. RESULTS: Among the 250 participants, most of the participants had encountered MDR-TB in their clinical practice, and the majority believe that MDR-TB is a rising problem. Although 88% of the participants did a GeneXpert assay before the start of anti-tubercular therapy (ATT), three-fourths of the participants knew that the assay detects the MTB genome and rifampicin resistance. MDR-TB was suspected in participants after no clinical improvement was observed after 3-6 weeks of a trial of ATT. Two-thirds of the participants knew that linezolid is currently being used as a second-line drug for the treatment of MDR- TB. The respondents in our survey mostly do not themselves treat MDR-TB and refer the patients to an MDR-TB center or a pulmonary medicine specialist. CONCLUSION: Healthcare practitioners (HCPs) with good knowledge levels can diagnose and treat TB patients appropriately, thus decreasing the rising MDR-TB problem, and they can educate patients and the general population about TB and the emerging MDR-TB situation. With the current level of knowledge about MDR-TB management, there is certainly an urgent need for educational and persuasive measures for the training of doctors in both the public and private sectors so as to achieve TB elimination by 2025.

The Threat of Impending Pandemics: A Proactive Approach.

The incessant occurrence of devastating health-related events, either on a large scale, such as pandemics, or in a local community in the form of sporadic outbreaks due to infectious agents, warrants a rapid, target-oriented, well-organized response team to combat the demonic consequences. While the world has been recovering from the clutches of the recent disastrous COVID-19 pandemic, the struggles against novel emerging and re-emerging pathogens such as monkeypox (mpox), newer evolving strains of influenza, Ebola, Zika, and the yellow fever virus continue to date. Therefore, a multisectoral, intercontinental, collaborative, interdisciplinary, and highly dedicated approach should always be implemented to achieve optimal health and avert future threats.

Pleural Empyema Due to Proteus Mirabilis in an Adult: A Rarely Encountered Clinical Scenario.

The presence of Proteus species in the pleural space is an uncommonly reported entity and is rarely seen even in patients with compromised immune status. We report a case of pleural empyema due to Proteus species in an adult oral cancer patient receiving chemotherapy for academic interest and for generating awareness regarding an expanded pathogenic spectrum of the organism. A 44-year-old salesman, non-smoker and non-alcoholic, presented with sudden-onset shortness of breath, left-sided chest pain, and low-grade fever of one-day duration. He had been recently diagnosed with adenocarcinoma of the tongue and had received two cycles of chemotherapy. After clinical and radiographic evaluation, the patient was diagnosed with left-sided empyema. Following thoracocentesis, the aspirated pus sent for bacterial culture yielded pure growth of Proteus mirabilis. Appropriately modified antibiotic therapy with parenteral piperacillin-tazobactam followed by cefixime, tube drainage, and other supportive therapy resulted in a favorable outcome. After three weeks of hospitalization, the patient was discharged for further planned management of his underlying condition. Though uncommon, the possibility of Proteus species should be kept in mind as a causative agent of thoracic empyema in adults, especially in immunocompromised patients with cancer, diabetes, and renal diseases. The so-called common microorganisms of empyema appear to have altered over time, influenced by anticancer therapy and underlying host immune status. Rapid diagnosis and appropriate antimicrobial therapy usually result in a favorable outcome.

A 54-Year-Old Woman With Rheumatoid Arthritis, Low-Grade Fever, and Cough.

CASE PRESENTATION: A 54-year-old Indian woman presented with low-grade fever and cough with expectoration for 1 month. Fever was not associated with any chills or night sweats. Expectoration was minimal in amount and mucoid in nature. Her appetite was decreased, without any significant weight loss. She denied any history of dyspnea or hemoptysis. The patient was diagnosed with rheumatoid arthritis 1 year previously and was initially started on methotrexate and short-term glucocorticoids. At the time of presentation, she was taking methotrexate 15 mg weekly and hydroxychloroquine 200 mg daily. Her joint disease was controlled on immunomodulators. She had no other comorbid condition, and she was a never smoker. She neither traveled within or outside India in the past nor came in contact with patients with pulmonary TB. A chest radiograph was done because a prior workup showed an ill-defined solitary nodular lesion in the right lower zone. She took a course of amoxicillin-clavulanate, but that was of no benefit.

Long COVID following Omicron wave in Eastern India-A retrospective cohort study.

Long coronavirus disease (COVID) or postacute sequelae of coronavirus disease of 2019 (COVID-19) is widely reported but the data of long COVID after infection with the Omicron variant is limited. This study was conducted to estimate the incidence, characteristics of symptoms, and predictors of long COVID among COVID-19 patients diagnosed during the Omicron wave in Eastern India. The cohort of COVID-19 patients included were adults (≥18 years) diagnosed as severe acute respiratory syndrome coronavirus 2 positive with Reverse Transcription Polymerase Chain Reaction. After 28 days of diagnosis; participants were followed up with a telephonic interview to capture data on sociodemographic, clinical history, anthropometry, substance use, COVID-19 vaccination status, acute COVID-19 symptoms, and long COVID symptoms. The long COVID symptoms were self-reported by the participants. Logistic regression was used to determine the predictors of long COVID. The median follow-up of participants was 73 days (Interquartile range; 67-83). The final analysis had 524 participants' data; among them 8.2% (95% Confidence Interval [CI]: 6%-10.9%) self-reported long COVID symptoms. Fatigue (34.9%) was the most common reported symptom followed by cough (27.9%). In multivariable logistic regression only two predictors were statistically significant-number of acute COVID-19 symptoms ≥ five (Adjusted odds ratio (aOR) = 2.95, 95% CI: 1.30-6.71) and past history of COVID-19 (aOR = 2.66, 95% CI: 1.14-6.22). The proportion of self-reported long COVID is considerably low among COVID-19 patients diagnosed during the Omicron wave in Eastern India when compared with estimates during Delta wave in the same setting.

A rare diagnosis of pulmonary actinomycosis by bronchoalveolar lavage cytology.

The role of a bronchoalveolar lavage sample cell block in the diagnosis of pulmonary actinomycosis.

Impact of Comorbidity Scores on the Overall Survival of Patients With Advanced Non-small Cell Lung Cancer: A Real-World Experience From Eastern India.

Introduction Lung cancer is the most common cancer, and it is the leading cause of cancer-related death. Smoking is the most common risk factor for the development of lung cancer. There is a lack of data on the comorbidities and outcomes of advanced non-small cell lung cancer (NSCLC) in the eastern part of India. This prospective study evaluated the impact of comorbidity scores on overall survival (OS) in these patients. Method This prospective cohort study was conducted on newly diagnosed advanced NSCLC patients between June 2020 and April 2021. These patients were given platinum-based doublet chemotherapy guided by histology and targeted therapy based on molecular studies. Comorbidities were assessed using the Charlson Comorbidity Index (CCI), Simplified Comorbidity Score (SCS), and Adult Comorbidity Evaluation-27 (ACE-27). The outcome assessed was OS. Overall survival was calculated in days from the date of start of anticancer therapy to the date of last follow-up or date of death. All enrolled patients were followed at regular intervals whenever they visited the hospital and telephonically until April 2022. The patients who were alive on April 30, 2022, were censored. The survival probability and median OS were calculated by Kaplan-Meier analysis, and group differences in comorbidity scores were analyzed with the log-rank test. A Cox proportional hazard analysis was performed to look for factors affecting overall survival. Results A total of 114 patients were enrolled in the study period, and the mean age of patients was 56.54 ± 11.03 years. Most of the patients were males (68.4%), and 52.6% were smokers. Adenocarcinoma was the most common histology (73.7%), followed by squamous cell carcinoma (25.4%). The median OS was 127 days (95% CI, 60-193 days). 33.4% of the patients had a CCI score of 0, a CCI score of 1 was seen in 57%, and ≥2 scores in 9.6%. SCS scores ≤9 and >9 were seen in 92.1% and 7.9% of patients, respectively. The ACE-27 score was none in 41 subjects, mild in 59, moderate in 12, and 2 NSCLC subjects had severe ACE-27 scores. The median OS for patients with a CCI score of 0 was 275 days (95% CI, 7-543 days), 114 days (95% CI, 85-142 days) for subjects with a CCI score of 1, and 402 days (95% CI, 0-844 days) for patients with a CCI score ≥2 (log-rank p = 0.215). Individuals with an SCS score ≤9 had a median OS of 175 days (95% CI, 91-258 days), and the median OS was 92 days (95% CI, 80-103 days) for patients with an SCS score >9 (log-rank p = 0.302). Median OS of the patients with ACE-27 score 0,1,2,3 were 297 days (95% CI, 76- 517 days), 117 days (95% CI, 81-152 days), 87 days (95% CI, 49-124 days) and 66 days, respectively (log-rank p=0.457). There was no statistical significance between comorbidity scores and OS. Worse OS was independently associated with poor performance status Eastern Cooperative Oncology Group (ECOG) ≥2 (hazard ratio [HR] 3.266; 95% CI 1.785-5.978; p = 0.00), neutrophil-to-lymphocyte ratio (NLR) <3 (HR, 2.35 95% CI 1.18-4.702; p = 0.015) and patients who were given compassionate tyrosine kinase inhibitors (TKIs) (HR, 7.396 95% CI 3.531-15.490; p = 0.000). Conclusions In our study, the advanced NSCLC patients who were given chemotherapy or oral TKIs showed no significant influence of comorbidities on overall survival. Factors independently associated with the worst survival were poor performance status (ECOG ≥ 2), NLR < 3, and patients who were given TKIs on a compassionate basis.

Indian Guidelines on Nebulization Therapy.

Inhalational therapy, today, happens to be the mainstay of treatment in obstructive airway diseases (OADs), such as asthma, chronic obstructive pulmonary disease (COPD), and is also in the present, used in a variety of other pulmonary and even non-pulmonary disorders. Hand-held inhalation devices may often be difficult to use, particularly for children, elderly, debilitated or distressed patients. Nebulization therapy emerges as a good option in these cases besides being useful in the home care, emergency room and critical care settings. With so many advancements taking place in nebulizer technology; availability of a plethora of drug formulations for its use, and the widening scope of this therapy; medical practitioners, respiratory therapists, and other health care personnel face the challenge of choosing appropriate inhalation devices and drug formulations, besides their rational application and use in different clinical situations. Adequate maintenance of nebulizer equipment including their disinfection and storage are the other relevant issues requiring guidance. Injudicious and improper use of nebulizers and their poor maintenance can sometimes lead to serious health hazards, nosocomial infections, transmission of infection, and other adverse outcomes. Thus, it is imperative to have a proper national guideline on nebulization practices to bridge the knowledge gaps amongst various health care personnel involved in this practice. It will also serve as an educational and scientific resource for healthcare professionals, as well as promote future research by identifying neglected and ignored areas in this field. Such comprehensive guidelines on this subject have not been available in the country and the only available proper international guidelines were released in 1997 which have not been updated for a noticeably long period of over two decades, though many changes and advancements have taken place in this technology in the recent past. Much of nebulization practices in the present may not be evidence-based and even some of these, the way they are currently used, may be ineffective or even harmful. Recognizing the knowledge deficit and paucity of guidelines on the usage of nebulizers in various settings such as inpatient, out-patient, emergency room, critical care, and domiciliary use in India in a wide variety of indications to standardize nebulization practices and to address many other related issues; National College of Chest Physicians (India), commissioned a National task force consisting of eminent experts in the field of Pulmonary Medicine from different backgrounds and different parts of the country to review the available evidence from the medical literature on the scientific principles and clinical practices of nebulization therapy and to formulate evidence-based guidelines on it. The guideline is based on all possible literature that could be explored with the best available evidence and incorporating expert opinions. To support the guideline with high-quality evidence, a systematic search of the electronic databases was performed to identify the relevant studies, position papers, consensus reports, and recommendations published. Rating of the level of the quality of evidence and the strength of recommendation was done using the GRADE system. Six topics were identified, each given to one group of experts comprising of advisors, chairpersons, convenor and members, and such six groups (A-F) were formed and the consensus recommendations of each group was included as a section in the guidelines (Sections I to VI). The topics included were: A. Introduction, basic principles and technical aspects of nebulization, types of equipment, their choice, use, and maintenance B. Nebulization therapy in obstructive airway diseases C. Nebulization therapy in the intensive care unit D. Use of various drugs (other than bronchodilators and inhaled corticosteroids) by nebulized route and miscellaneous uses of nebulization therapy E. Domiciliary/Home/Maintenance nebulization therapy; public & health care workers education, and F. Nebulization therapy in COVID-19 pandemic and in patients of other contagious viral respiratory infections (included later considering the crisis created due to COVID-19 pandemic). Various issues in different sections have been discussed in the form of questions, followed by point-wise evidence statements based on the existing knowledge, and recommendations have been formulated.

A Delphi consensus statement for the management of post-COVID interstitial lung disease.

INTRODUCTION: As millions of people worldwide recover from COVID-19, a substantial proportion continue to have persistent symptoms, pulmonary function abnormalities, and radiological findings suggestive of post-COVID interstitial lung disease (ILD). To date, there is limited scientific evidence on the management of post-COVID ILD, necessitating a consensus-based approach. AREAS COVERED: A panel of experts in pulmonology and thoracic radiology was constituted. Key questions regarding the management of post-COVID ILD were identified. A search was performed on PubMed and EMBASE and updated till 1 March 2022. The relevant literature regarding the epidemiology, pathophysiology, diagnosis and treatment of post-COVID ILD was summarized. Subsequently, suggestions regarding the management of these patients were framed, and a consensus was obtained using the Delphi approach. Those suggestions which were approved by over 80% of the panelists were accepted. The final document was approved by all panel members. EXPERT OPINION: Dedicated facilities should be established for the care of patients with post-COVID ILD. Symptom screening, pulmonary function testing, and thoracic imaging have a role in the diagnosis. The pharmacologic and non-pharmacologic options for the management of post-COVID ILD are discussed. Further research into the pathophysiology and management of post-COVID ILD will improve our understanding of this condition.

Comparison of Diagnostic Yield and Complications in Ultrasound-Guided Closed Pleural Biopsy Versus Thoracoscopic Pleural Biopsy in Undiagnosed Exudative Pleural Effusion.

Introduction Malignancy, tuberculosis, and non-tubercular pleural infections account for most exudative pleural effusion. Pleural fluid cytology, biochemical tests and even pleural fluid cell block studies may fail to yield a diagnosis in certain cases. Medical thoracoscopy is the gold standard for the diagnosis of unexplained pleural effusions. However, access to medical thoracoscopy may be limited, particularly in developing countries. Also, certain patients may not be fit to undergo the procedure because of medical conditions. An ultrasound-guided pleural biopsy is an option in such conditions. The present study is intended to compare the diagnostic yield and complications of both methods of pleural biopsy in undiagnosed exudative pleural effusion under a randomized controlled trial. Method After fulfilling all the inclusion criteria, participants were randomized to either ultrasound-guided closed pleural biopsy or thoracoscopic-guided pleural biopsy groups. The primary outcome was to compare the diagnostic yield of ultrasound-guided Tru-Cut® (Newtech Medical Devices, Faridabad, India) closed pleural biopsy versus thoracoscopic pleural biopsy, and the secondary outcomes were to compare the complications rate, duration of the procedure, and hospital stay in the patients undergoing ultrasound-guided pleural biopsy versus thoracoscopic pleural biopsy, and predictors of a positive biopsy result in both groups. Result A total of 118 patients with pleural effusion were screened; 39 of them who were eligible, randomized into the ultrasound group (20 patients) and the thoracoscopic group (19 patients). The median age of participants was 53.5 (50-58) years and 55 (45-64) years in the ultrasound and thoracoscopic groups, respectively. Pleural fluid cell count, protein, adenosine deaminase (ADA), and lactate dehydrogenase (LDH) were similar in both groups, although pleural fluid glucose was low in the ultrasound group. Diagnostic yield was 90% (18/20) and 94.7% (18/19) in the ultrasound and thoracoscopic groups, respectively, which was statistically non-significant (p=0.963). The median duration of hospital stay was 9.5 (5.3-27) days and 15 (12-22) days in ultrasound and thoracoscopic groups respectively. The thoracoscopic group had a more prolonged stay compared to the ultrasound group, but it was statistically non-significant (p=0.09). The duration of the procedure was significantly longer in the thoracoscopic group 90 (85-105) minutes, in comparison to ultrasound 47.5 (41.3-55) minutes (p=0.001). No major complications were seen in both groups. Subcutaneous emphysema was the most common complication in the thoracoscopic group (10%), followed by hemorrhage (5.3%), and respiratory failure (5.3%). Hypotension was the only complication in the ultrasound group (5%). The rate of complications was significantly higher in the thoracoscopic group (p<0.01). Conclusion Ultrasound-guided closed pleural biopsy is as good as thoracoscopic pleural biopsy in undiagnosed exudative pleural effusion. It was associated with a shorter procedure duration, a shorter hospital stay, and fewer complications as compared to thoracoscopic biopsy. Both the procedures were safe in experienced hands and a hospital setup, but the thoracoscopic pleural biopsy was associated with complications.

Burden of melioidosis in India and South Asia: Challenges and ways forward.

Melioidosis is caused by the environmental bacterium Burkholderia pseudomallei. South Asia is estimated to have 44% of the global disease burden. Among South Asian countries, Bangladesh and Sri Lanka are considered endemic for melioidosis; a few cases have been reported from Nepal, and a few imported cases from Pakistan have also been reported. India has experienced an increase in numbers of melioidosis cases in the recent years. The bacteria is inherently present in the soil and enters the human body via skin abrasions, inhalation, or ingestion. As clinicians are often ignorant about the similar characteristics of this disease and several other common tropical diseases, it causes a major delay in the timely diagnosis and management. The organism is easily mistaken as Pseudomonas spp in microbiology laboratories and may be dismissed as a common laboratory contaminant. The poor diagnostic sensitivity of blood culture also leads to missed diagnosis. Hence, both clinical ignorance and missed laboratory diagnosis have misrepresented melioidosis as a rare entity. The key preventive interventions are avoiding contact with loose and muddy soils of meliodosis-endemic areas, and provision of safe drinking water. The present article describes the various possible attributes for melioidosis underdiagnosis and the challenges of improving the diagnosis in conjunction with viable solutions. Funding: None.

Tuberculosis and COVID-19: An epidemic submerged in the pandemic: A case series and review of current literature.

Tuberculosis (TB), the leading infectious cause of death worldwide, like coronavirus disease 2019 (COVID-19), is mainly transmitted through the respiratory route and affects the lungs. Though TB-COVID co-infection is not common, but might be missed due to similar clinical presentation. Therefore, a high index of suspicion of co-infections is needed so that there is prompt diagnosis and appropriate treatment. A higher mortality of 13% in cases of co infections is alarming. Here we are reporting a case series of SARS-CoV-2 - TB co-infection from Eastern India.

Comparison of Clinical Presentation and Vaccine Effectiveness Among Omicron and Non-omicron SARS Coronavirus-2 Patients.

Introduction The rapidly mutating Omicron SARS-CoV-2 variant has replaced the previous dominant SARS-CoV-2 variants like alpha, and delta resulting in the amplification of coronavirus disease 2019 (COVID-19) cases. The present study was conducted to compare the clinical profile and vaccination status in patients infected with Omicron and non-Omicron SARS-CoV-2 variants. Methods All patients who tested positive for coronavirus disease 2019 (COVID-19) during the study period (January 2022 to February 2022) were further tested for detection of SARS-CoV-2 Omicron variant by using Omisure kit (TATA MD CHECK RT-PCR, TATA MEDICAL AND DIAGNOSTICS LIMITED, Tamil Nadu, INDIA). Clinico-demographic factors and vaccination status were compared between both Omicron and non-Omicron groups. Results A total of 1,722 patients who tested positive for COVID-19 were included in the study, of which 656 (38.1%) were Omicron and 1,066 (61.9%) were non-Omicron SARS-CoV-2 variants. Blood group and vaccination status were the major predictors for Omicron. The proportion of male patients was 58.4% in the Omicron group and 57.9% in the non-Omicron group. Maximum cases (86.2%) belonged to >18-60 years age group, 7.3% to >60 years age group, and least to 0-18 years (6.5%). The average age of the study participants was 35.4 ± 14.5 years. Vaccinated participants had less chance of having Omicron than the unvaccinated participants (p-value - 0.003). Fever and loss of smell were found to be significantly associated with the non-Omicron SARS-CoV-2 variant. (p-value < 0.05). Conclusion The present study reflects that the clinical course of the disease is milder in Omicron as compared to the non-Omicron variant. However rapid rise in cases can badly affect the healthcare system demanding good preparedness to tackle all the predicaments. Good Vaccination coverage should be of utmost priority irrespective of the variant type.

Seroprevalence of SARS-CoV-2 antibodies among healthcare workers in a teaching hospital in Eastern India.

STATEMENT OF THE PROBLEM: Healthcare workers (HCW) are the most vulnerable group for contracting SARS-CoV-2. Assessment of seroprevalence of SARS-CoV-2 antibodies among HCW, thus can provide important data on pathogen exposure, infectivity, and adherence to personal protective equipment (PPE). The present study aimed at assessing SARS-CoV-2 seroprevalence among HCW and exploring associations with demographics, category of exposure to COVID-19 patients, preventive measures taken and relation with COVID-19 symptoms. METHOD OF STUDY: HCWs with a minimum gap 2 weeks from last duty were eligible to participate in the study. The enrolled HCW were categorized into high-risk and low-risk category based on work in COVID-19 areas. HCWs SARS-CoV-2 specific IgG and IgM antibodies were detected using rapid immunochromatography test. RESULTS: Out of 821 randomly selected HCWs, either IgM or IgG antibody was detected in 32 HCWs (32/821, 3.9%). Only IgM antibodies were detected in 14 (1.7%), only IgG was detected in 9 (1.0%), and both IgM and IgG antibodies were present in 9 HCWs. Seropositivity was significantly higher in high-risk category (5.7% vs. 2.2.%), HCWs who ever had COVID-19 related symptoms in last 3 months (5.6% vs. 2.8%), and those who had earlier tested positive for SARS-CoV-2 with real-time reverse transcriptase PCR (36.6% vs. 3.5%). Seroprevalence was highest (6.9%) among housekeeping and sanitation staff. CONCLUSIONS: Overall, low seroprevalence of SARS-CoV-2 antibodies in our HCWs is an indicator of effective infection control practice. HCW posted in dedicated COVID ward need more stringent implementation of infection prevention measures.

Prophylactic Role of Ivermectin in Severe Acute Respiratory Syndrome Coronavirus 2 Infection Among Healthcare Workers.

Introduction Healthcare workers (HCWs) are vulnerable to getting infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Preventing HCWs from getting infected is a priority to maintain healthcare services. The therapeutic and preventive role of ivermectin in coronavirus disease 2019 (COVID-19) is being investigated. Based on promising results of in vitro studies of oral ivermectin, this study was conducted with the aim to demonstrate the prophylactic role of oral ivermectin in preventing SARS-CoV-2 infection among HCWs at the All India Institute of Medical Sciences (AIIMS) Bhubaneswar. Methods A prospective cohort study was conducted at AIIMS Bhubaneswar, which has been providing both COVID and non-COVID care since March 2020. All employees and students of the institute who provided written informed consent participated in the study. The uptake of two doses of oral ivermectin (300 µg/kg/dose at a gap of 72 hours) was considered as exposure. The primary outcome of the study was COVID-19 infection in the following month of ivermectin consumption, diagnosed as per Government of India testing criteria (real-time reverse transcriptase polymerase chain reaction [RT-PCR]) guidelines. The log-binomial model was used to estimate adjusted relative risk (ARR), and the Kaplan-Meier failure plot was used to estimate the probability of COVID-19 infection with follow-up time. Results Of 3892 employees, 3532 (90.8%) participated in the study. The ivermectin uptake was 62.5% and 5.3% for two doses and single dose, respectively. Participants who took ivermectin prophylaxis had a lower risk of getting symptoms suggestive of SARS-CoV-2 infection (6% vs 15%). HCWs who had taken two doses of oral ivermectin had a significantly lower risk of contracting COVID-19 infection during the following month (ARR 0.17; 95% CI, 0.12-0.23). Females had a lower risk of contracting COVID-19 than males (ARR 0.70; 95% CI, 0.52-0.93). The absolute risk reduction of SARS-CoV-2 infection was 9.7%. Only 1.8% of the participants reported adverse events, which were mild and self-limiting. Conclusion Two doses of oral ivermectin (300 µg/kg/dose given 72 hours apart) as chemoprophylaxis among HCWs reduced the risk of COVID-19 infection by 83% in the following month. Safe, effective, and low-cost chemoprophylaxis has relevance in the containment of pandemic alongside vaccine.

Evaluation of spirometry as a parameter of response to chemotherapy in advanced lung cancer patients: A pilot study.

CONTEXT: Spirometry is an important tool to monitor treatment response in diseases such as chronic obstructive pulmonary disease and asthma. However, there is lack of evidence to support its application to evaluate response to chemotherapy in advanced lung cancer. It might be a useful adjunct to the imaging-based response evaluation which lacks functional assessment of lungs. AIMS: The study was conducted to evaluate the change in spirometry in lung cancer patients after chemotherapy and to find its correlation with change in physical tumor size. SUBJECTS AND METHODS: Sixty-two advanced lung cancer patients who were eligible for palliative chemotherapy were enrolled. Baseline tumor size evaluation using Response Evaluation Criteria in Solid Tumor (RECIST)-based scoring system, and spirometry was done. Four cycles of double agent (platinum doublets) chemotherapy were administered, after which treatment response was evaluated. Repeat spirometry was analyzed and correlated with changes in physical tumor size. RESULTS: Twenty-five patients showed a response (all partial response) to four cycles of chemotherapy. Small cell carcinoma showed a better response rate than non-small cell carcinoma (78% vs. 39%). There was statistically significant improvement in forced expiratory volume in 1 (FEV1) (P = 0.01) and forced vital capacity (P = 0.03) in responders as compared to nonresponders. Change in FEV1 showed a statistically significant correlation with the change in tumor size (RECIST score) (r = -0.34; P = 0.04). CONCLUSIONS: Improvement in spirometry correlates with the tumor response as judged using RECIST criteria after chemotherapy. Further studies with bigger sample size are required to consolidate the results.